Predictive factors, management, and clinical outcomes of coronary obstruction following transcatheter aortic valve implantation: Insights from a large multicenter registry

Henrique B. Ribeiro, John G. Webb, Raj R. Makkar, Mauricio G. Cohen, Samir R. Kapadia, Susheel Kodali, Corrado Tamburino, Marco Barbanti, Tarun Chakravarty, Hasan Jilaihawi, Jean Michel Paradis, Fabio S. De Brito, Sergio J. Cánovas, Asim N. Cheema, Peter P. De Jaegere, Raquel Del Valle, Paul T.L. Chiam, Raúl Moreno, Gonzalo Pradas, Marc RuelJorge Salgado-Fernández, Rogerio Sarmento-Leite, Hadi Daood Toeg, James L. Velianou, Alan Zajarias, Vasilis Babaliaros, Fernando Cura, Antonio E. Dager, Ganesh Manoharan, Stamatios Lerakis, Augusto D. Pichard, Sam Radhakrishnan, Marco Antonio Perin, Eric Dumont, Eric Larose, Sergio G. Pasian, Luis Nombela-Franco, Marina Urena, E. Murat Tuzcu, Martin B. Leon, Ignacio J. Amat-Santos, Jonathon Leipsic, Josep Rodés-Cabau*

*Corresponding author for this work

Research output: Contribution to journalArticle

267 Scopus citations

Abstract

Objectives This study sought to evaluate the main baseline and procedural characteristics, management, and clinical outcomes of patients from a large cohort of patients undergoing transcatheter aortic valve implantation (TAVI) who suffered coronary obstruction (CO). Background Very little data exist on CO following TAVI. Methods This multicenter registry included 44 patients who suffered symptomatic CO following TAVI of 6,688 patients (0.66%). Pre-TAVI computed tomography data was available in 28 CO patients and in a control group of 345 patients (comparisons were performed including all patients and a cohort matched 1:1 by age, sex, previous coronary artery bypass graft, transcatheter valve type, and size). Results Baseline and procedural variables associated with CO were older age (p < 0.001), female sex (p < 0.001), no previous coronary artery bypass graft (p = 0.043), the use of a balloon-expandable valve (p = 0.023), and previous surgical aortic bioprosthesis (p = 0.045). The left coronary artery was the most commonly involved (88.6%). The mean left coronary artery ostia height and sinus of Valsalva diameters were lower in patients with obstruction than in control subjects (10.6 ± 2.1 mm vs. 13.4 ± 2.1 mm, p < 0.001; 28.1 ± 3.8 mm vs. 31.9 ± 4.1 mm, p < 0.001). Differences between groups remained significant after the case-matched analysis (p < 0.001 for coronary height; p = 0.01 for sinus of Valsalva diameter). Most patients presented with persistent severe hypotension (68.2%) and electrocardiographic changes (56.8%). Percutaneous coronary intervention was attempted in 75% of the cases and was successful in 81.8%. Thirty-day mortality was 40.9%. After a median follow-up of 12 (2 to 18) months, the cumulative mortality rate was 45.5%, and there were no cases of stent thrombosis or reintervention. Conclusions Symptomatic CO following TAVI was a rare but life-threatening complication that occurred more frequently in women, in patients receiving a balloon-expandable valve, and in those with a previous surgical bioprosthesis. Lower-lying coronary ostium and shallow sinus of Valsalva were associated anatomic factors, and despite successful treatment, acute and late mortality remained very high, highlighting the importance of anticipating and preventing the occurrence of this complication.

Original languageEnglish (US)
Pages (from-to)1552-1562
Number of pages11
JournalJournal of the American College of Cardiology
Volume62
Issue number17
DOIs
StatePublished - Oct 22 2013

Keywords

  • coronary obstruction
  • coronary occlusion
  • percutaneous aortic valve replacement
  • percutaneous coronary intervention
  • transcatheter aortic valve implantation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Ribeiro, H. B., Webb, J. G., Makkar, R. R., Cohen, M. G., Kapadia, S. R., Kodali, S., Tamburino, C., Barbanti, M., Chakravarty, T., Jilaihawi, H., Paradis, J. M., De Brito, F. S., Cánovas, S. J., Cheema, A. N., De Jaegere, P. P., Del Valle, R., Chiam, P. T. L., Moreno, R., Pradas, G., ... Rodés-Cabau, J. (2013). Predictive factors, management, and clinical outcomes of coronary obstruction following transcatheter aortic valve implantation: Insights from a large multicenter registry. Journal of the American College of Cardiology, 62(17), 1552-1562. https://doi.org/10.1016/j.jacc.2013.07.040